- Palliative Care Northumbria integrated multiple separate palliative care services into a single comprehensive service working with community health services and social care. - They partnered with organizations like Macmillan Cancer Support and Marie Curie to expand services, including creating a unique Marie Curie @ Northumbria partnership and a Rapid Response community palliative care team. - This service transformation helped support more patients in their preferred places of care, with deaths at home or in palliative care settings increasing and hospital deaths decreasing.

1. Palliative Care Northumbria
Dr Eleanor Grogan, consultant palliative medicine and head
of service
@NorthumbriaNHS @drelliegrogan

2. Northumbria Healthcare NHS Foundation Trust
• Delivers hospital and community health services in Northumberland and
North Tyneside and adult social care services in Northumberland in
partnership with Northumberland County Council.
• We cover one of the largest geographical areas of any provider in the UK –
over 2,500 square miles.
• We serve a population of more than 500,000 people across Northumberland
and North Tyneside.

4. Palliative Care Northumbria
• Service transformation:
o integrated multiple separate services
o created single comprehensive Palliative Care service
working alongside community health services and
social care within one organisation
• Supported and strengthened by ambitious, innovative partnership working with
Macmillan Cancer Support, Clinical Commissioning Groups (CCGs) and Marie Curie
to create a unique MarieCurie @ Northumbria partnership
• See patients in their own homes, in emergency, district general and community
hospitals, care homes, day hospice and NHS specialist palliative care inpatient units.

5. Palliative
Care
Northumbria
North Northumberland
Community team - Alnwick
base
Central/SE Northumberland
Community - Ashington base
Hospital liasion / PCU - WGH
Macmillan care support team
N Tyneside
Community including Rapid
response/ day hospice / NH
team - Wallsend base
Hospital liasion / PCU - NTGH
Macmillan care support team
W Northumberland
Community / hospital liasion
team - Hexham base
NSECH
Hosiptal liasion team - NSECH
base
Marie Curie Hospice Newcastle
Providing consultant services to
hospice
Bereavement, befriending &
information services
Trust wide

6. Palliative Care Northumbria improves patient care
and experience by:
• Supporting patients to stay at home, thereby avoiding
preventable hospital admissions
• Seeing patients promptly when in hospital and quickly
facilitating their preferred place of care
• Ability to admit patients directly to an NHS inpatient
specialist palliative care unit, often the same day the referral is made.

7. Palliative Care Northumbria: Leadership
• The vision for our specialist services is clinically-led
• Palliative Care Northumbria management structure:
o Clinical head of service (three-year rotation)
o Senior manager
o Operational manager
o MarieCurie @ Northumbria modern matron for
palliative and end of life care
• Provides both continuity and an injection of fresh ideas when a new head of
service is appointed

8. Palliative Care Northumbria: Innovations
• Innovative NHS inpatient Palliative Care Units in North Tyneside and
Northumberland since 2009 and 2012 respectively
• Unique MarieCurie @ Northumbria partnership created
by working with Marie Curie and CCGs enabled:
o First modern matron post in palliative and end of life care
o Expansion of the hospital palliative care liaison team
with a range of nursing skills and grades
o Development of a new seven- day Rapid Response
community palliative care service to support patients in
urgent need and help them to remain in their preferred place of care

9. Palliative Care Northumbria: Innovations
• MarieCurie @ Northumbria partnership helped
expansion and merger of existing hospital palliative
care team leading to development of palliative care
service at flagship Northumbria Specialist Emergency
Care Hospital, as well as ongoing support at our
general hospitals
• Care Home Team, in partnership with North Tyneside CCG, was set up to
improve the quality of care delivered to patients living in the care home
sector and avoid unnecessary hospital admissions.

10. Palliative Care Northumbria: Innovations
• Longstanding relationship with Macmillan Cancer Support
• Some posts have been adopted by Macmillan enabling access to
Macmillan’s educational resources and training
• Befriending, bereavement and information services working across all areas
• Recent developments include:
o New social work posts to provide specialist social workers for palliative
care patients
o Adoption and re-naming of our home carer service to Macmillan Care
Support Team

11. Successful service transformation
• Supporting patients’ choice about their preferred place of death:
o Increased proportion of deaths in usual place of residence from 39.1% in
2008/9 to 53.9% in 2015 North Tyneside; and 39.3 to 47.6% in
Northumberland
o Increased proportion of deaths in palliative care settings
o Reduced proportion of deaths in hospitals
• Change in hospital palliative care team activity since merging service:
o Number of patients seen has increased by 100%
o Supporting more patients with a wider range of diagnoses

12. Successful service transformation
• In 2016-17 our care home team helped support almost 81% of patients to
remain in their nursing home until death
• Rapid Response community palliative care
team had 1337 referrals January – June 2017
with only 3% of those patients being admitted
to hospital or hospice.

13. Patient Experience
“We have only been in
for a few days but in
that time they have
shown us compassion,
care and love. They
bring ice lollies around
and they make sure
Dad’s mouth is kept
clean.”
“There is a lovely caring
atmosphere. You can
sense it. There are
families in all day visiting
their poorly loved ones
and it’s nice to see.”
“The care here is the best. They are all fantastic and
empathetic. I have watched them with some of the
other patients on the ward and they take their time with
them, making sure they have all they need before
leaving their bedside. I am very grateful for the care I
have received here.”
High scoring patient experience feedback for both
Palliative Care Units.
Recent comments from patients and relatives:
“It’s a fantastic ward. The staff
here put their heart and soul into
patient care.”

14. Key learning points from our service development
• Be brave enough to challenge the norms within your service
• Ask how things could be improved. Ask this from the perspective of a patient or family
member
• Ask what would improve the experience of a patient who uses your service
• Have a model of clinical leadership
o empower staff who are working directly with patients by involving them in decisions
o support this with a team of managerial staff who can help realise the clinical vision
• Talk to the natural partners and allies of your service, such as Marie Curie and
Macmillan - ideas can be better achieved by working together.

15. Thank you